Risperidone and Post-op Delirium

Puja Trivedi, DO

Anesthesiology. 2012 May;116(5):987-97.

Early Treatment with Risperidone for Subsyndromal Delirium after On-pump Cardiac Surgery in the Elderly: A Randomized Trial.

Hakim SM, Othman AI, Naoum DO.

Sources estimate that up to 80% of post cardiac surgery patients experience post operative delirium which has a known association with prolonged ICU stays, ICU readmissions, unnecessary examinations and neurology consults, patient and family frustration and dissatisfaction and as recently noted in the Journal of Thoracic Surgery, increased incidence of strokes. It is for this reason Hakim et al decided to study the effect of early diagnosis and treatment of post operative delirium. The aim of this randomized, parallel-arm trial was to study the effect of treating subsyndromal delirium with risperidone on the incidence of clinical delirium in elderly patients who underwent on-pump cardiac surgery. One hundred one patients aged 65 yr or older who experienced subsyndromal delirium after on-pump cardiac surgery were randomized using a computer-generated list to receive 0.5 mg risperidone or placebo every 12 h by mouth. Patients were assessed at 8 h by a blinded observer using the Intensive Care Delirium Screening Checklist, and those scoring more than 3 were evaluated by a blinded psychiatrist to confirm delirium. Patients in either group who experienced delirium were treated according to the same algorithm. Initially, risperidone was administered and if symptoms were not controlled, haloperidol was administered. Seven (13.7%) patients in the risperidone group experienced delirium versus 17 (34%) in the placebo group (P = 0.031). Due to small patient size, the fact that there is no definitive diagnosis of subsyndromal delirium or accepted diagnostic exam, no consensus on the role of risperidone as a first line agent to treat delirium, cross over obscurity since patients in the placebo portion were given risperidone and/or haldol, as well as the potential side effects; risperidone for the treatment for subsyndromal delirium needs to be further studied before it can be adopted into mainstay practice.